adherence to hypertension treatment, African American women, high blood pressure, Hill-Levine framework



  1. Fongwa, Marie N. PhD, RN, MPH
  2. Evangelista, Lorraine S. PhD, RN
  3. Doering, Lynn V. DNSc, RN, FAAN


Hypertension (HTN) is a major public health problem in African American women. The disproportionate rate of HTN in African American women makes it a high-priority national health objective. Lack of access to a regular continuous source of care may be particularly significant among African American women because such a source of care is a prerequisite to early diagnosis and successful treatment. Understanding the factors that influence access to care for HTN in African American women will provide the information needed to improve the use of healthcare services and enhance adherence to treatment. Despite the known importance of adherence to successful HTN treatment, few attempts have been made to incorporate the indicators of adherence to HTN treatment into a theoretical model that can be used to guide research and practice with African American women. The adapted Hill-Levine model offers an appropriate framework for studying these phenomena in African American women because factors frequently associated with seeking and using healthcare services are organized in three dimensions, including predisposing, enabling, and reinforcing factors. This article discusses the magnitude of the problem presented by HTN and lack of HTN control in African American women, identifies from the literature the factors related to adherence to treatment in HTN management, in general, and in African American women, specifically, and uses the adapted Hill-Levine model to organize the identified predisposing, enabling, and reinforcing factors associated with adherence to HTN treatment recommendations among African American women.